SQL Developer Claims - Remote​/Telecommute

Job Title

Pay Range: $25hr - $30hr

• Strong SQL skills with experience querying large, complex datasets.
• Experience supporting healthcare claims processing systems (e.g., Facets or similar).
• Understanding of batch scheduling, automation tools, and production monitoring.
• Familiarity with Service Now incident management.
• Ability to work effectively in a 24x7 production support environment.

• Monitor and support end-to-end claims batch processing, pre-adjudication, and related data transfers.
• Investigate and analyze pre-adjudicated and impacted claims; determine root cause and recovery actions.
• Execute batch job re-runs, backfills, and recoveries following approved runbooks.
• Perform claims reconciliation activities and validate claim counts, dollar amounts, and processing outcomes.
• Provide on-call SME support for claims processing incidents and high-volume seasonal events.
• Monitor batch jobs and Tidal automation schedules for in-scope claims applications.
• Respond to monitoring alerts, initiate incident tickets, and escalate per operational procedures.
• Perform PEGA dashboard monitoring, JVM health checks, and application availability checks.
• Participate in incident bridges and Client calls, providing technical analysis and status updates.
• Use complex SQL queries to analyze claims data, investigate processing failures, and validate reconciliations.
• Support incident troubleshooting through data analysis and ad-hoc reporting.
• Partner with application teams to understand database structures supporting claims workflows.
• Log, triage, track, and manage incidents in Service Now through resolution.
• Assist with Root Cause Analysis (RCA) efforts for recurring or high-impact incidents.
• Track corrective and preventive actions to closure.
• Contribute to operational, SLA, and KPI reporting.
• Maintain operational documentation, runbooks, and knowledge articles.
• Identify opportunities for process improvement and automation.

• Knowledge of EDI 837 transactions and claims data flows.
• Experience in regulated healthcare or government programs.
• Prior production support or operations experience in a claims environment.